Left bundle branch area pacing significantly reduced the composite of death or heart failure hospitalization compared with biventricular pacing (20.8% vs 28%; HR 1.495; 95% CI 1.213-1.842; P<0.001).
Observational
Yes
Does left bundle branch area pacing reduce the composite of death or heart failure hospitalization compared to biventricular pacing in patients with LVEF ≤35% and CRT indications?
1,778 patients with LVEF ≤35% who underwent BVP or LBBAP for the first time for Class I or II indications for CRT from January 2018 to June 2022 at 15 international centers. Mean age 69 ± 12 years, 32% female, 48% had coronary artery disease.
Left bundle branch area pacing (LBBAP)
Biventricular pacing (BVP)
Composite endpoint of time to death or heart failure hospitalization (HFH)composite
Left bundle branch area pacing is associated with a lower risk of death or heart failure hospitalization and greater improvement in LVEF compared to traditional biventricular pacing in patients with CRT indications.
背景：双腔起博（BVP）作为心脏再同步治疗（CRT）手段，已被证实适用于左室射血分数（LVEF）降低、心力衰竭及宽QRS或预计频繁室性起搏患者。近期研究显示左束支区域起博（LBBAP）是BVP的安全替代方案。目的：本研究旨在比较接受CRT患者中BVP与LBBAP的临床结局。方法：本观察性研究纳入2018年1月至2022年6月期间，在15个国际中心根据心脏再同步治疗I级或II级指征首次进行BVP或LBBAP的LVEF≤35%的患者。主要终点为死亡或心力衰竭住院（HFH）时间的复合终点。次要终点包括死亡、HFH及超声心动图变化。结果：共纳入1778例患者，BVP组981例，LBBAP组797例。平均年龄69±12岁，女性32%，冠状动脉疾病48%，平均LVEF 27%±6%。LBBAP组起搏后QRS波时程较基线显著变窄（128±19 ms vs 161±28 ms；P<0.001），也显著窄于BVP组（144±23 ms；P<0.001）。CRT后，LBBAP组LVEF由27%±6%提升至41%±13%（P<0.001）；BVP组由27%±7%提升至37%±12%（P<0.001），LBBAP组基线改善幅度显著大于BVP组（13%±12% vs 10%±12%；P<0.001）。多变量回归分析显示LBBAP相比BVP显著降低主要终点风险（20.8% vs 28%；HR: 1.495；95% CI: 1.213-1.842；P<0.001）。结论：LBBAP较BVP在CRT适应患者中改善临床结局，可能是BVP的合理替代方案。
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Pugazhendhi Vijayaraman
Parikshit S. Sharma
Óscar Cano
Journal of the American College of Cardiology
Imperial College London
Baylor College of Medicine
University of Ottawa
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Vijayaraman 等人（Sun,）开展了一项观察性研究，纳入左室射血分数降低且符合心脏再同步治疗指征的患者（n=1778）。比较了左束支区域起博（LBBAP）与双腔起博（BVP）对死亡或心力衰竭住院复合终点的影响（HR 1.495，95% CI 1.213-1.842，p<0.001）。左束支区域起博显著降低了该复合终点的发生率，相较于双腔起博（20.8% vs 28%；HR 1.495；95% CI 1.213-1.842；P<0.001）。
www.synapsesocial.com/papers/69ed841d27c2c78c57d1e0c1 — DOI: https://doi.org/10.1016/j.jacc.2023.05.006
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